内镜诊断上消化道同时性多原发癌的价值

近年来,内镜诊断上消化道多原发癌的报道日渐增多,但对其诊断价值缺乏客观的评价、作者通过对具有内镜活检和术后病理完整资料的49例上消化道多发癌灶患者进行分析,探讨内镜对上消化道同时性多原发癌的诊断价值。     

食管、胃同时性多原发癌的诊断和治疗

同时性多原发癌指在同一个时期发生在一个脏器或不同脏器的2个以上的原发癌．其发生机制可能与细胞突变及机体免疫功能缺陷有关．内镜检查是目前诊断食管、胃同时性多原发癌的主要手段，少数可经X线或手术探查发现，临床上为了减少漏诊，作内镜检查时应尽可能将全程查完多原发癌的诊断标准作者沿用国内学者刘复生提出的4条诊断标准．目前治疗食管、胃同时性多原发癌较困难．主要依癌灶组合及病情而定．到目前为止，手术治疗食管、胃同时性多原发癌仍是主要措施，所以凡是贲门－胃组合或食管下段－贲门组合以及胃自身组合者，应尽可能手术治疗，有条件的食管自身组合的亦可考虑手术治疗，不能一次性手术者视病情而定，可行手术十放疗或化疗，亦可放疗＋手术＋化疗祖国医学中有多种药物能起到治疗癌肿作用，对于不能手术治疗及放疗、化疗的患者尤应一试，有些病例能收到意想不到的效果．总之，食管、胃同时性多原发癌的治疗应采取积极的综合措施治疗，不管患者病情如何，都不应轻易放弃治疗．     

消化系多原发癌研究进展

此文对近年来有关消化系多原发癌的诊断、发病机制、临床特点、治疗、预后等方面的研究进行总结。人体的同一脏器或不同脏器发生多个原发癌称多原发癌。在多原发癌中,不同脏器发生者为多重癌。消化系多原发癌的发病机制与微卫星不稳定性(MSI)和基因突变有关。消化系统本身好发癌肿,而消化系伴多原发癌也好发于消化系本身,多原发癌的治疗选择根治性为主的治疗方法。多原发癌中异时性多原发癌预后明显较同时性多原发癌好。     

升结肠、肝脏多原发癌的诊治经过：1例报道

多原发癌(multiple primary cancer, MPC)的发生屡见不鲜,本院收治1例有乙肝病史的升结肠、肝脏双肿瘤患者,临床诊断为升结肠癌并肝脏转移,予3个疗程术前新辅助化疗后行手术切除,术后病理提示升结肠、肝脏MPC。结肠、肝MPC与结肠癌并肝转移瘤的治疗及预后是有差异的,这个病例提示我们,在无法明确诊断时,为不延误患者的治疗,需要通过穿刺活检来确定肿瘤性质。     

多原发癌46例临床分析

目的探讨多原发癌的临床特点、治疗和预后。方法分析首都医科大学石景山教学医院北京市石景山医院肿瘤科和北京中西医结合医院肿瘤科收治的46例多原发癌的发病年龄、发病部位、首发癌与第2原发癌的间隔时间以及生存时间。结果本组46例多原发癌中,异时性多原发癌41例,同时性多原发癌5例。首发癌和第2原发癌的中位年龄分别为69岁和77岁,胃肠道为好发部位。肿瘤间隔时间5年组的中位生存期为240个月,肿瘤间隔时间≤5年组的中位生存期为84个月,两组间差异具有统计学意义(P=0.005)。首发癌术后5年的生存率为76.1%。第2原发癌治疗后5年生存率为21.7%。第2原发癌手术组的中位生存时间为60个月,非手术组的中位生存时间为48个月,两组比较,差异具有统计学意义(P=0.032)。结论对于多原发癌患者,根治性手术可延长其生存时间,肿瘤间隔时间愈长,生存期愈长。对多原发癌患者的治疗应持积极态度,只要肿瘤及患者情况允许,应尽量手术切除。     

累及消化系统的多原发癌20例临床分析

随着老龄人口的增多和诊断技术的进步,多原发癌已变得更加常见.早期发现第二原发癌进行根治性治疗而识别多原发癌的特征十分重要.消化系统是包括多个器官,其发生多器官多原发癌较为常见.本文对近4年来我科收治的20例至少有一个原发癌累及消化系器官的多原发癌进行分析,以提高其诊断和治疗水平.     

老年双原发癌患者细胞免疫功能的变化

有关多原发癌的报道较多，但多是从临床流行病学、病理及随访等方面加以分析报道。老年双原发癌患者细胞免疫功能变化的研究，国内未见报道，本院对１４例老年双原发癌患者细胞免疫功能进行了检测，现结果报道如下。１资料与方法１．１临床资料本组１４例双原发癌均经病理...     

腹膜活检对结核性腹膜炎的诊断价值

目的评价经皮腹腔穿刺腹膜活检对结核性腹膜炎的诊断价值。方法使用自动弹簧活检针对34例临床上考虑为结核性腹膜炎患者进行腹膜活检，并进行病理诊断。结果34例患者均经一次穿刺取出腹膜壁层组织，经病理证实结核性腹膜炎26例、转移性腺癌3例、恶性淋巴瘤1例和大致正常腹膜组织4例，一次穿刺活检成功率为100％，经活检明确腹水病因的诊断率为88．2％。结论腹膜活检对结核性腹膜炎诊断及鉴别诊断，有重要的临床诊断价值。     

老年性上消化道多原发癌21例内镜、病理分析

0 引言上消化道是多原发癌的好发部位,近几年来国内报导逐渐增多,有资料统计约占上消化道肿瘤0.4%-10.07%.而老年性上消化道多原发癌的发病较多,为了解老年组上消化道多原发癌情况,统计了我院消化科1990/2000年10年间的上消化道内镜检查资料36916例,经内镜、病理诊断为上消化道癌3267例,多原发癌32例,其中老年性上消化道多原发癌21例,现将老年性多原发癌内镜检查结果、镜下发现部位及病理诊断分析如下:     

大肠多原发癌的诊断和漏诊分析

大肠多原发癌的诊断和漏诊分析江西医学院第一附属医院（南昌，３３０００６）刘俊王崇文胡伟万荣大肠多原发癌可同时或异时发生。因此大肠多原发癌易导致漏诊或误诊为复发、转移而造成治疗上的错误。本文报道我院１０年间８４３例大肠癌中的多原发癌２６例，占同期大肠癌...     

47例肝脏占位性病变患者肝脏病理检查与血生化联合检测的对比研究

目的评价肝脏活组织病理检查对早期诊断原发性肝癌的临床价值及其与血清甲胎蛋白（AFP）、碱性磷酸酶（AKP）、γ-谷氨酰转移酶（GGT）指标和影像学的相关性,以提高原发性肝癌的早期诊断率。方法对47例影像学检查提示肝脏占位性病变并进行肝活检患者进行回顾性分析。结果临庆诊断为原发性肝癌的患者47例,病理检查证实28例,临床诊断与病理检查符合率为59．60％,1例外科手术切除前肝活检未查见癌细胞的患者,术后证实为胎儿型肝母细胞瘤,有2例做肝活检2次,有2例做肝活检3次而查见癌细胞。结论肝活检是诊断原发性肝癌的金标准,但在临床应用过程中存在客观误差,需多次多部位多方向取材,并结合血生化指标及影像学检查,以提高早期肝癌的诊断率。     

针型胸腔镜在晚期肺癌病理学诊断和分期中的价值

目的 探讨针型胸腔镜活检术在晚期肺癌病理学诊断和分期中的临床应用价值。方法 对经胸部螺旋CT和磁共振(MRI)检查临床诊断为Ⅲa～Ⅳ期肺癌，行痰、胸液细胞学和纤维支气管镜等检查，未能获得病理诊断的94例患，施行针型胸腔镜肺内原发病灶、纵隔淋巴结、肺内和胸壁转移病灶组织活检术。结果 94例患中89例经针型胸腔镜取得病理学标本，成功率为95％；术后病理均诊断为肺癌，其中腺癌47例，鳞癌23例，腺鳞癌12例，小细胞肺癌7例。经胸腔镜活检病理检查后，15例(17％)肺癌患病理分期得到更正；4例发生气胸，11例出现轻度皮下气肿，2例出现少量咯血；89例患术后8～18个月均获随访并行螺旋CT检查，无胸壁针道的肺癌种植性转移。结论 对常规检查方法不能明确病理诊断和病理分期的晚期肺癌患，针型胸腔镜活检术可作为一种有效的确诊手段。     

肺肉瘤样癌2例并文献复习

目的提高对肺肉瘤样癌（lung sarcomatoid carcinoma,LSC）的诊断、治疗及预后方面的认识。方法通过对2例LSC患者的诊治进行分析,结合相关文献复习。结果患者表现为咳嗽、咯血、胸痛,其症状与其它类型肺癌相似,增强CT示环形强化为其特征。肺组织活检确诊肺肉瘤样癌（病理及免疫组化）。手术联合化/放疗可延长患者生存时间。结论肺肉瘤样癌罕见,较一般肺癌更具侵袭性,预后差。本病缺乏特异性临床表征,增强CT扫描示环形强化为其特征,但诊断主要依靠手术病理。手术是LSC的首选治疗方法。     

Transbronchial fine needle aspiration cytological examination: a useful tool for diagnosing primary lung cancer

BACKGROUND: Obtaining a definitive preoperative diagnosis plays a critical role in deciding upon the treatment approach for lung carcinoma. However, success in making definitive diagnoses of small primary lung cancers will require new approaches because these cancers are difficult to detect using standard biopsy procedures. METHODS: We evaluated the results of morphologic definitive diagnosis together with various clinical factors in 1003 primary lung cancers resected surgically. Patients underwent transbronchial brushing, fine needle aspiration cytology, forceps biopsy, and/or forceps biopsy-stamp cytology for preoperative diagnoses, in conjunction with the use of Diff-Quik to confirm that hits had been made on the radiographic shadows before terminating the examinations. RESULTS: Sensitivities of the diagnostic procedures for primary lung cancers were as follows: 64.8% for brushing, 56.1% for transbronchial forceps biopsy, 72.0% for transbronchial forceps biopsy-stamp cytology, and 86.4% for transbronchial fine needle aspiration. The four transbronchial biopsy procedures had a combined overall sensitivity of 92.7%. In patients with peripheral lung cancers of 2 cm or less in diameter, transbronchial fine needle aspiration had a sensitivity of 75.9%, which was the highest sensitivity for all transbronchial examinations. In the subset of 296 patients who underwent all four transbronchial biopsy examinations, transbronchial fine needle aspiration had the highest sensitivity of preoperative diagnosis of all the transbronchial examination methods. CONCLUSIONS: The sensitivity of preoperative cytological diagnosis for primary lung cancers, especially transbronchial aspiration cytology, is high. Transbronchial fine needle aspiration cytology is useful for the preoperative diagnosis of primary lung cancer.     

OPTIMUM NUMBER OF PERCUTANEOUS TRANSHEPATIC CHOLANGIOSCOPY‐GUIDED BIOPSIES FOR HISTOLOGIC DIAGNOSIS OF BILE DUCT CARCINOMA

Background: Percutaneous transhepatic cholangioscopy (PTCS)‐guided biopsy is used for the diagnosis of bile duct carcinoma, but the number of biopsy specimens required for diagnosis is unclear. The aim of this study was to clarify whether multiple PTCS‐guided biopsies are needed for accurate histologic diagnosis. Methods: We examined the relationships between size of the first biopsy specimen, endoscopic, cholangiographic, and pathologic features, and the presence of carcinoma in the first biopsy specimen of the primary lesion in 27 bile duct carcinomas. Results: Twenty‐six of 27 carcinomas (96%) were histologically diagnosed by PTCS‐guided biopsy; 20 (74%) were detected in the first biopsy specimen, six in the second or third biopsy specimen, and one was not detected in four biopsy specimens. Carcinomas with papillogranular mucosa by endoscopy, convex margins by cholangiography, or macroscopic types (except for sclerosing type) were detected on the first biopsy specimen more frequently than were others (15/15 vs 5/12, P <0.001; 13/13 vs 7/14, P <0.01; and 15/16 vs 5/11, P <0.01, respectively). There was no relationship between positivity for carcinoma and size of the first biopsy specimen, vascular dilatation by endoscopy, or histologic type. With the combination of preoperative endoscopy and cholangiography, main lesions with papillogranular mucosa and/or convex margins were proven to be carcinoma on the first biopsy specimen significantly more frequently than were others (17/17 vs 3/10, P <0.0001). Conclusion: If the main lesion contains neither papillogranular mucosa nor a convex margin, multiple PTCS‐guided biopsies should be performed in order to increase the sensitivity for diagnosing bile duct carcinoma.     

Lung cancer cell type as a determinant of bronchoscopy yield

The accuracy of diagnosis of lung cancer obtained by fiberoptic bronchoscopy utilizing sputum cytology and bronchial biopsy depends on the size, location, and number of biopsy samples taken from the tumor. We have found that the accuracy of diagnosis also depends upon the histologic type of cancer. Fiberoptic bronchoscopy (brushings, washing, and biopsies) was performed and sputum cytology and bronchial tissue was obtained from 51 patients with histologically-proven lung cancer. The bronchial biopsy was more sensitive than the bronchial washing and brushing techniques in detecting primary bronchogenic and metastatic carcinoma. It was positive in ten of ten patients with small cell carcinoma, 12 out of 20 cases of squamous cell carcinoma, three of four cases of adenocarcinoma, and three of four patients with large cell cancer. The bronchial biopsy yield was influenced by the histologic cell type with the highest diagnostic yield being found with small cell carcinoma.     

细支气管肺泡癌75例临床分析

目的 总结经病理证实的75例细支气管肺泡癌（BAC）的临床特征和诊断方法.方法 对我院2001年1月～2010年6月收治的75例BAC进行回顾性分析.结果 75例BAC患者男女比例为1∶1.34,平均年龄56.9岁,吸烟者占12％; CT检查58例表现为孤立结节型,8例为弥漫结节型,9例为炎症浸润型;26例患者行CT或超声引导下经皮肺穿刺活检,22例获得确诊,9例行支气管镜检查,仅1例确诊,52例为手术后组织活检确诊.结论 BAC的临床特征不同于其他类型肺癌,CT检查有助于BAC的诊断,而经皮肺穿刺活检则能提高BAC诊断的正确率.     

X-ray diagnosis of synchronous multiple primary carcinoma in the upper gastrointestinal tract

AIM:To analyze the radiological features of multiple primary carcinoma (MPC) in the upper gastrointestinal (GI) tract,study its biological characteristics and evaluate X-ray examination in its diagnosis. METHODS:Hypotonic double-contrast GI radiography was performed in 59 multiple primary carcinoma cases,pathologically proved by surgery or endoscopy biopsy. Radiological findings were analyzed. RESULTS:Of the 59 cases,esophageal MPC (EMPC) was seen in 24,esophageal and gastric MPC (EGMPC) in 27 and gastric M...     

Prostatic metastasis of large cell neuroendocrine carcinoma of the lung

Large cell neuroendocrine carcinoma (LCNEC) of the lung is a rare and aggressive tumour with a poor prognosis. Lung cancer metastases to the prostate are also uncommon, and are usually found incidentally during autopsy. Most reported primary lung cancers with prostatic metastases are small cell carcinomas, and prostatic metastases from LCNEC of the lung have not been reported previously. This case report describes a 70-year-old man with LCNEC of the lung and metastases in the prostate, brain, bone, liver and lymph nodes.     

Small-cell carcinoma of the rectum

Small-cell carcinoma of the rectum is a rare tumor. We treated a patient with small-cell carcinoma of the rectum with radiation and multidrug regimen being used for small-cell carcinoma of the lung. Within two months of chemotherapy, the primary lesion, as evaluated by rectoscopy, biopsy, and CT scan, had resolved completely. The patient was in complete remission for 12 months after initiation of chemotherapy and died of widespread metastases. At autopsy, no residual tumor was found in the rectum. This case stresses the importance of ultrastructural study in the differential diagnosis of small-cell cancer of the rectum and the fact that this tumor can be treated in the same fashion as for small-cell carcinoma of the lung with multidrug chemotherapy and radiation therapy to achieve local control.